Effects of Bundled Presimulation Training on Maternal Care Performance and Interruption Response

BACKGROUND: Maternal mortality demands nurses who can manage critical care in interruption-prone environments. Simulation-based learning (SBL) offers realistic practice for interruption management, but its effectiveness depends on well-designed pretraining. METHOD: A randomized, between-subjects design examined how varying levels of pretraining affect task completion, cognitive load, and interruption management among nursing students playing RNs as active participants (AP), passive observers (PO), or active observers (AO). RESULTS: Learners receiving the pretraining plus just-in-time (JIT) reflection showed greater SBL task completion and lower cognitive load. Among observers, AOs reported comparable cognitive load to APs. Response to interruptions varied by task, with predictive cues used most during medication administration. Intervention groups consistently used interruption management strategies more than the control group. CONCLUSION: Interruption management skills are needed in all tasks, not just medication administration. Nurse educators should incorporate structured pretraining and JIT reflection into SBL. Active observation is recommended to ensure equitable learning outcomes across roles.